OBSERVATIONS ON THE USE OF THIOURACIL

Publisher Website
Google Scholar
Abstract
Seventy patients with thyro-toxicosis ranging in age from 16-82 yrs. were treated with thiouracil during a period of 21/2 yrs. Forty had toxic adenomata and 30 toxic diffuse goiter. On an avg., initial dose of 0.6 g. daily which was gradually reduced with improvement, successful remission was produced in 6-7 wks. Previous I delayed the desired effect. Only one patient failed to respond to the drug probably because of prolonged I admn. Ten patients, 6 with toxic adenoma and 4 with toxic diffuse goiter, have remained in remission for 6-24 mos. The period of treatment in these was never less than 6 mos., and averaged 13 mos. Four patients developed myxedema which was readily controlled by stopping the drug for one wk. and resuming at a lower dosage level. These are now taking from 1/4 to 1/2 grain thyroid substance daily in addition to the maintenance dose of thiouracil. It is believed essential, when prolonged treatment is planned, to administer small amts. of thyroid substance in addition, after remission has been induced by thiouracil and a maintenance dose established . Exophthalmos was not increased and showed measurable improvement in 6 of 9 patients. Slight increase in thyroid size was noted at first, more pronounced in those with toxic diffuse goiter. The gland tended to diminish in size as treatment progressed. Thyrotoxic auricular fibrillation was promptly controlled and normal sinus rhythm established. Diabetes complicating toxic adenomata was improved as remission set in but when it was associated with toxic diffuse goiter it remained uninfluenced. Hyperthyroidism induced by thyroid substance responded promptly to treatment with thiouracil. Three instances of acute thyroiditis rapidly subsided with this treatment. Borderline or occult hyperthyroidism was readily recognized by the response to thiouracil. Sixteen patients with recurrent hyperthyroidism have been controlled by this treatment so that further operation has not been necessary. One patient developed agranulocytosis on the 59th day after 10.1 g. of thiouracil. Recovery occurred after 1 wk. of parenteral penicillin. Five patients developed drug fever and 2 a generalized urticarial eruption. Thiouracil is today the most effective agent for inducing remission in thyrotoxicosis. It makes for simpler, less costly pre-operative prepn., and smoother, shorter convalescence. It is indicated in the treatment of patients who are poor surgical risks and those with recurrent hyperthyroidism.
Keywords